atsi adult health check checklist for medical director by Nc7M7xzF

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									  ABORIGINAL & TORRES STRAIT ISLANDER ADULT HEALTH CHECK FORM *
              * Refer to Medicare item 710 and the relevant explanatory notes before using this checklist.
Patient's Surname: <<Patient                   Other names:<<Patient Demographics:First
Demographics:Surname>>                         Name>>
Patient Contact Details: Home Ph <<Patient Demographics:Phone (Home)>>
                                       Mobile Ph <<Patient Demographics:Phone (Mobile)>>
                                     Work Ph <<Patient Demographics:Phone (Work)>>
Alternative Contact Details:
DOB: <<Patient Demographics:DOB>>              Age: <<Patient Demographics:Age>>
Doctor: <<Doctor:Name>>                        Date/s check provided:
Patient Gender: <<Patient Demographics:Sex>>
Patient consent:                   Date:    /    /
Previous Health Check              Date:      / /

                                                                                             Please tick 
The Health Check                                                                           when/if completed
Identification:                   Aboriginal                                            Mandatory
                                    Torres Strait Islander
                                    Aboriginal and Torres Strait Islander
Pre Check                                                                                
Explanation of check and likely benefits to patient                                      Mandatory
Verbal or written consent given by patient                                               Mandatory
Personal details (name, age, gender) and contact details                                 Mandatory
Alternative contact details                                                              recommended
Obtain and examine previous patient records                                              recommended
History
Patient medical history and Current health problems                                      Mandatory
Risk factors                                                                             Mandatory
Family medical history                                                                   Mandatory
Medication usage (including OTC and prescribed)                                          Mandatory
Immunisation status (refer to current schedule)                                          Mandatory
Sexual and reproductive health                                                           Mandatory
Physical activity, nutrition and alcohol, tobacco or other substance use                 Mandatory
Hearing loss                                                                             Mandatory
Mood (depression and self-harm risk)                                                     Mandatory
Family relationships (is the patient a carer or cared for by others?)                    Mandatory
Visual acuity (recommended for people over 40)                                           if indicated
Work status (eg paid/unpaid, CDEP, in training or education)                             if indicated
Environmental and living conditions                                                      if indicated
Other history as considered necessary by the practitioner or collector                   if indicated
Examination of the patient
Measurement of blood pressure, pulse rate and rhythm                                     Mandatory
Measurement of height and weight to calculate BMI                                        Mandatory
Measure waist circumference for central obesity                                          if indicated
Oral examination (gums and dentition)                                                    Mandatory
Ear and hearing (otoscopy)                                                               Mandatory
Whisper test                                                                             if indicated
Urinalysis (dipstick) for proteinurea                                                    Mandatory
Reproductive and sexual health examination                                               if indicated
Trichiasis check                                                              if indicated
Skin examination                                                              if indicated
Visual acuity (recommended for people over 40)                                if indicated
Other examinations considered necessary by the practitioner                   if indicated
Investigations as required
Fasting blood sugar and lipids         (lab. based test on venous sample)     if indicated
Random blood glucose                                                          if necessary
Pap smear                                                                     if indicated
STI testing (urine or endocervical swab for chlamydia/gonorrhoea              if indicated
especially for those aged 15-35 years)
Mammography (schedule appointment/refer directly)                             if indicated and eligible
Other investigations considered necessary by practitioner and in              if indicated
accordance with current recommended guidelines
Intervention                                                                  
Assess patient’s risk factors                                                 Mandatory
Discuss results of check with patient                                         Mandatory
Discuss risk factors with patient                                             as indicated
Provide preventive health advice                                              as indicated
Provide intervention activity:
       Initiation of treatment                                                if indicated
       Immunisation                                                           if indicated
       Referral                                                               if indicated
       Education, advice or assistance(eg pre-pregnancy, safer sex, social    if indicated
    & family issues)
Other interventions considered necessary by practitioner                      if indicated
Documentation of simple strategy of good health for patient                   Mandatory
Record of health check kept on file                                           Mandatory
Offer patient a written report about the health check, with recommendations   Mandatory
about matters covered by the health check and a simple strategy for good
health of the patient.
The report may include:
      - Assessment of patient's overall health;
      - Risk factors identified for the patient;
      - Results of tests undertaken and what they mean;
The simple strategy for good health should include:
      - Identification of required treatment/services; and
          - Actions the patient should take.

Register patient for two yearly reminder of check                             recommended


								
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